The principal investigator (PI) is currently funded by the K12 mechanism at Duke University. This career development proposal describes a continuation and expansion of the mentored training and research plan to develop the PI as an independent clinician-scientist by the conclusion of the award period. The Duke Eye Center and Duke University (sites of training) are outstanding training environments with numerous resources, interactions, facilities, and unique learning opportunities. Duke has made a strong commitment to training and supporting the next generation of clinician-scientists. The PI is similarly committed to a career as a clinician- scientist. The PI's research focuses on the development and clinical translation of diagnostic optical devices to address challenges in ophthalmic care. This research proposal uses spectral domain optical coherence tomography (SDOCT) imaging to examine the optical consequences of corneal endothelial keratoplasty (EK) and proposes a novel method to model and predict these optical changes prior to transplantation. Corneal EK has become the treatment of choice in the surgical management of corneal endothelial dysfunction such as Fuchs' corneal endothelial dystrophy but has had unintended optical consequences. The first aim describes the creation of a predictive optical model of the procedure outcome based on in situ imaging of the host and donor corneal tissues. The second aim describes validation of the image based model with clinical outcomes after corneal EK. The results of this study will provide preliminary data as the basis for an independent research proposal to better predict and target refractive results after keratoplasty. To achieve both the short- term career development and research goals, the PI will continue to receive didactic training in both biomedical engineering and clinical research and will be mentored by a multi-disciplinary team of biomedical engineers, and clinician-scientists. In the long-term, the PI will use the knowledge and training from this career development period to continue diagnostic optical device development and early stage clinical translation of these devices to address clinical ocular pathologies.